Medicare Part A - The Benefit Periods and Deductibles

Did you know that Medicare Part A deductibles are different than most health insurance deductibles? Rather only being charge once a year like most health or other insurance deductibles, Part A deductibles are charged for each benefit period rather than for the entire year. 

What is a Part A benefit period?

A benefit period is the way the Original Medicare Part A measures your use of inpatient hospital and skilled nursing facility services. It begins the day that you enter a hospital or skilled nursing facility and ends when you have not received inpatient hospital or Medicare covered skilled care in a skilled nursing facility for 60 days in a row. The benefit period is not tied to the calendar year.

You must meet your Part A deductible at the beginning of each benefit period as well as pay a daily coinsurance depending on how many days you stay at the hospital or skilled nursing facility during one benefit period.

If you go into the hospital or skilled nursing facility after one benefit period has ended (more than 60 days after you left), then a new benefit period begins and you are responsible to pay for a new deductible. There is no limit to the number of benefit periods you can have, or how long a benefit period can be.

Example: One benefit period could actually span more than one hospitalization. Imagine you are in the hospital for a short stay and then you’re released. Then a few days later you you need to go back into the hospital. Your benefit period would still in effect. In this particular situation, you would be charged just one deductible.

Lifetime Reserve Days

In Original Medicare, these are additional days that Medicare will pay for when you're in a hospital for more than 90 days. You have a total of 60 reserve days that can be used during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for a daily coinsurance.1

Medicare Advantage plans set their own cost sharing terms.  

So if you are on a Medicare Advantage plan, your plan may or may not charge deductibles for hospital stays depending on your specific plan. Some plans may charge a flat amount per hospitalization up to a set number of days. Other plans may charge a copay or coinsurance amount for each day in the hospital. Call the member services phone number on the back of your plan member ID card to find out details specific to your plan.

Some additional web links for more info: Glossary of Terms

What Is a Medicare Hospital Benefit Period? (AARP)

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